Author Information

Toshinobu Saito,

Yukihiro Hojo,

Takaaki Katsuki and

Kazuomi Kario

Background

Although diabetes mellitus (DM) is widely known as a risk factor of cardiovascular disease, a number of large clinical trials have showed that intense blood sugar control failed to reduce cardiovascular events. It is suggested that glycemic instability called oscillation of blood sugar may confer additional risk to the cardiovascular complications over mean level of blood sugar. However, it is not clear whether oscillation of blood sugar contribute to cardiovascular events in coronary artery disease (CAD) with DM. The purpose of this study is to clarify oscillation of blood sugar related to the cardiovascular events in CAD patients with DM.

Methods

We studied 365 CAD patients with DM (age=64.5±9.1, male/female=287/78). All patients have received successful coronary revascularization by percutaneous intervention. Major adverse cardiovascular events (MACE) was defined as composite events of admission for congestive heart failure, fatal arrhythmia, revascularization for angina, acute myocardial infarction, stroke, intervention for peripheral arterial disease and all causes of death. We followed up these patients for 1001±724 days and collected the data of their blood sugar levels during following period.

Results

Kaplan Meier curve analysis showed that the incidence of MACE were significantly different among three groups divided by percentile of difference in blood sugar (delta BS) during the study period (log rank test x2=8.13, p=0.02). Logistic regression analysis showed that delta BS is a significant factor for occurrence of MACE (odds ratio=1.35, p=0.03). On the other hand, among the groups divided by hemoglobin A1c (HbA1c) tertile, Kaplan Meier curve analysis showed that the incidence of MACE was NOT significantly different.

Conclusion

MACE in CAD patients with DM was associated with delta BS, but not with HbA1c. These results suggest that short-term blood sugar control is important for the prevention of MACE in CAD patients with DM.

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